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Business Highlights: Health Plans

Lori Schoonmaker meets with a health plan customer

Lori Schoonmaker, senior vice president of national markets with Highmark Inc., meets with a health plan customer to ensure continuous care during a time of transition in the western Pennsylvania marketplace.

Members' care ensured through transition in western Pennsylvania

The western Pennsylvania health care marketplace began to shift significantly with the change in contractual arrangements effective at year-end 2014. Highmark's goal, said Highmark Health Plan President Deborah Rice-Johnson, is "doing what is right for our members, which is ensuring they have access to high-quality, affordable health care across the region."

The new arrangement addressed the importance of continuity of care for Highmark members in the midst of treatment at UPMC. However, thousands of members had to find new physicians and hospitals. As a result, Highmark's top priority became planning and managing the orderly transition of western Pennsylvania health plan members to contracted providers, including providers within the affiliated Allegheny Health Network, the lead company in Highmark Health's integrated delivery network, and community-based hospitals and independent providers.

Highmark implemented new processes — in medical management, sales, marketing and operations — to manage the transition of members and coordinated, consistent communications with those migrating to new providers. And during this transition, Highmark continued to develop high-quality and reduced-cost products and services, including tiered networks and consumer-focused health plans to meet the changing needs of all members, renewing and new.